H04-007A1 – Home Care Agency Letter
February 4, 2004
TO:Home Care Agencies
Implementation of the In-home Nurse Delegation Program became effective for Home and Community Services and Area Agencies on Aging (HCS/AAA) clients on December 1,2003. This letter describes the Nurse Delegation Program and the information you may need to decide whether your agency will participate in providing delegated nursing tasks to HCS clients.
The New Law
Revisions to the Nurse Delegation law, which passed in June 2003, enables nurse delegation to take place in an individual’s private home. The Nurse Delegation Program has been functioning in community-based settings, such as adult family homes, since 1996. Under this program, nursing assistants either registered or certified by Washington State are allowed to perform a delegated task, such as administering medication or monitoring blood glucose levels, when trained and periodically supervised by a registered nurse. The training is specific to a particular client, and only those clients determined to be “stable and predictable” by the delegating nurse at the time the task is delegated are eligible for this program.
The revision of the Department of Health (DOH) In-Home Services licensing law in 2003 allows employees of a home care agency to perform a delegated task. WAC 246-335-015(21) allows a home care agency to provide delegated tasks of nursing under RCW 18.79.260 (3)(e) without jeopardizing their license as a home care agency. This means that home care agency staff could perform the delegated nursing task, and also that the agency could contract with, but not directly employ a registered nurse to provide staff training, client assessment, and supervision for nurse delegated tasks.
Requirements for Delegated Caregivers
Before performing a delegated task, the caregiver must meet some basic requirements. First, they must be currently registered or certified as a nursing assistant. If registered as a nursing assistant, the caregiver must have completed “Fundamentals of Caregiving”; second, both nursing assistants-registered (NA-R) and nursing assistants-certified (NA-C) must have completed the class “Nurse Delegation for Nursing Assistants.” Third, each nursing assistant must keep his/her license current and without restriction.
Home Care Agencies
February 4, 2004
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The “Nurse Delegation for Nursing Assistants” training is a nine-hour course and is available in a self-study format or a classroom setting.
Payment for Registration and Tuition
HCS will pay the registration fee for an agency caregiver who is going to perform a delegate a nursing task for an HCS client to become registered or certified. In addition, HCS will reimburse the agency at the regular training rate for both class tuition and training wages for caregivers who will be performing a delegated task for an eligible HCS client.
The registration fee for eligible caregivers not previously registered or certified may be paid with a voucher available from the HCS social worker or AAA case managers. The case managers also have access to the application to register a caregiver as an NA-R. There is no cost to the agency to have eligible workers registered.
Would the Nurse Delegation Course qualify as CE credits?
The nurse delegation course will qualify for nine CE credits and can be done in a classroom or self-study format.
Responsibility of the Home Care Agency
The agency continues to be responsible for assuring that a worker is sufficiently trained to meet the client’s needs for assistance. In this case the client needs nurse delegation, and therefore the worker assigned to the client must meet the requirements for performing a delegated task. The training for the task specific to the client remains the responsibility of the delegating nurse- not the agency. The agency is responsible to schedule the worker(s) and supervise the personal care of the client in the usual manner.
Contracts with Nurses
The new law also allows home care agencies to contract with a registered nurse who will delegate nursing tasks to their caregivers. However, ADSA already has over 90 registered nurses under contract throughout Washington State. Some of these nurses have been delegating to caregivers in adult family homes since 1996 and are available to continue to do so in private homes. These nurses and their contracts are managed by the statewide Nurse Delegation Program Managers at HCS. Therefore, it is not necessary for a home care agency to contract with a nurse separately, if they do not wish to do so.
Nurse Delegation Trainings
ADSA Program Managers began conducting training for HCS and AAA staff starting in November 2003. Some home care agencies have attended these trainings or have received information on the program through attendance at the Washington State Association of Home Care Services meetings.
Home Care Agencies
February 4, 2004
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If you have further questions about this program please feel free to contact us for additional information.
Sincerely,
Cynthia Arnett Kay Kramer Sievers
Program Manager Program Manager
Nurse Delegation Nurse Delegation
360-725-2553 360-651-6828